Open season for cold and flu

Vaccination push

According to Alastair Buxton, director of NHS services at Community Pharmacy England, the changing start dates of the vaccination services caused unnecessary work and hassle for pharmacy owners and their teams. “The public can and will be relying on community pharmacies again this year to do what they do best: providing valuable services such as vaccinations to prevent flu and Covid, recommending OTC products to ease cold symptoms, and giving wider advice on how to stay healthy this winter,” he says, urging pharmacists to review all available guidance and resources for autumn/winter NHS services. 

The UK Government is recommending that, where possible, patients should be able to have flu and Covid-19 vaccinations at the same time. However, the changes in vaccination eligibility may have caused some confusion and frustration. “People have been coming into the pharmacy since August asking if they will be eligible for NHS flu vaccinations this year,” says Richard Evans, community pharmacist in Wales and member of the RPS Welsh Pharmacy Board. 

“Eligibility in Wales is the same as in England. Flu vaccinations are not available for free on the NHS for the under 65s this year, unless they are in an at-risk category, and there have been many last-minute changes to the vaccination schedule. If customers are not in the eligible categories but feel they still need the flu jab, it’s an opportunity to promote the pharmacy’s private service if this is available.”

Some community pharmacies are part of the NHS Vaccination Programmes in Scotland at a local level, but there isn’t a national service delivered through community pharmacy. Community pharmacies provide NHS flu vaccinations as part of the public health service. “This service offers opportunistic contributions to the preventative health agenda and includes the promotion and support of a pro-active approach to self-care for patients,” says a CPS spokesperson.

Williams says it’s important to encourage customers to have the flu vaccination and dispel any worries or concerns. “Look at how the vaccination programme can be further targeted to protect the vulnerable,” he says. “This may mean reaching out and engaging with certain groups in the community. Different parts of society and different people have a different mindset about vaccinations. But ultimately, they invest trust in pharmacists to help them make the right choices.” 

There are concerns that university students may be at an increased risk of meningitis due to low vaccination coverage. According to the UKHSA in August 2023, vaccine coverage data shows around one in eight new students going to college and university this year remain unprotected against the four strains of meningococcal bacteria. 

Managing pharmacy supplies

Evans says that last year’s strep A surge caused significant problems with supplies of cold and flu medicines. “There were also breaks in the supply chains, so these couldn’t cope with the demand,” he says. “Common medicines such as Lemsip and cough syrup were very difficult to order in. Many people wanted popular cold and flu remedies to ease their symptoms, but we couldn’t supply them.”

Williams stresses that the resilience of the supply chain shouldn’t be the responsibility of community pharmacies, but pharmacies can still plan ahead. “It’s important to make sure the right systems are in place within the pharmacy, bearing in mind that stock management can easily be technology-led,” he says. “We need to stock a range of products in line with the needs of the community and help people to access the care they need, while avoiding the temptation to stockpile. Make sure there is something for every type of patient, such as those with existing medical conditions, sugar-free formulations for those with diabetes, and also medicines for children.”

The cost-of-living crisis continues to escalate, which means customers are likely to be looking for affordable, effective cold and flu medicines – even more so than in previous years. Because certain brands weren’t available last year, some customers may have already switched to generic or cheaper versions.

“Around half of customers will ask for products by the brand name,” says Evans. “Obviously, there’s a big price difference between branded and unbranded versions. It’s important to explain to customers that they can buy an unbranded version at a fraction of the price and that these are the same products and have the same effects. In the past, if customers couldn’t get the brand they wanted, they didn’t want anything else, but many have become more aware of generics over the last few years.”

Baker says the cold and flu season provides an ideal opportunity for link selling. “Customers are more likely to test for illnesses since Covid-19 and also wear masks to protect others, so keeping tests and masks in stock will help to maximise sales,” she says. 

Healthcare advice

According to Baker, being able to distinguish between cold, flu and Covid-19 symptoms will be particularly important over the coming months.

Williams says this is the ideal time to make sure the whole pharmacy team is up to speed and to look for any gaps in their knowledge. “The new variant of Covid has emerged before we get back into the full winter season,” he says. “Successful training will mean fewer referrals to the pharmacist. We need to explain to customers that most people don’t need antibiotics for their symptoms, while identifying those who do need them.” 

The cold and flu season provides an opportunity to discuss general health issues with customers, such as sleeping well, looking after their weight, and smoking cessation. “Going into the winter months, evidence shows that people find it more difficult, physically and emotionally, as it gets darker and the weather seems less appealing,” says Williams. “Covid and flu vaccinations are a great way to get messages across, beginning with the question, ‘How are you planning to look after yourself this winter?’ 

“We are running two winter programmes this year: one involving referral for social isolation, and the other about keeping warm in the cold weather.”

O’Brien has noticed that more customers are asking for advice on keeping their immune system healthy. “People are realising there’s so much they can do themselves,” he says. “Vitamin D supplements should be taken from September until March. Higher doses of 4,000 to 5,000 units per day show the best results, as long as there are no contraindications, such as sarcoidosis. It takes around six weeks for vitamin D levels to build up, so it’s important to start taking the supplements early on, from when summer stores start depleting.”

Other dietary supplements are important for the immune system as well, but it’s important to take budget into consideration. 

“Vitamin C can also be helpful to treat a cold or flu, but again this needs to be in high doses – around 1,000 mg of vitamin C every two or three hours while the infection is present,” says O’Brien. “It’s expensive to take it four to five times a day, so I recommend a budget brand. Zinc is another useful supplement, but needs to be taken with copper as it can deplete copper stores.”

Eating well is important too. “Reducing sugar in the diet helps the immune system,” says O’Brien. “Sugar depletes many essential nutrients, such as magnesium, zinc and B vitamins. It also leads to a drop in energy levels, which encourages people to then eat more sugar. 

“There’s concern about how many and how quickly antibiotics are prescribed for cold and flu symptoms. Research shows that taking probiotics alongside antibiotics helps to reduce antibiotic resistance and the frequency of antibiotic prescribing.”